Southern DHB has released its final plan for its Integrated Primary Maternity System of Care with a strong emphasis on greater sustainability of the LMC midwifery workforce, as it seeks to provide greater support for women and their families across the district.

The new system of care has the following key features:

· Introduction of a new layer of maternity support, named Maternal and Child Hubs, to extend the reach of services across the district and provide greater infrastructure support for LMC midwives

· Funding support package for LMC midwives working in remote rural locations, to recognise the additional duties they perform

· Investment in technology to support access to specialist care, reducing the need to travel

· Dedicated positions and resources to provide leadership support to promote quality and safety, recruitment and retention of LMC midwives, and communication.

In the plan, maternal and child hubs will be developed in Wanaka, Te Anau, Lumsden, Tuatapere and Ranfurly. These are non-birthing units (except in urgent situations) that bring together resources to better support antenatal and postnatal care.

Primary birthing units are maintained at Lakes District Hospital in Queenstown, Gore Health, Oamaru Hospital and Clutha Health First in Balclutha, Winton Maternity Centre; and will continue at Charlotte Jean Maternity Hospital in Alexandra while the best long-term location of a primary birthing unit in Central Otago is explored.

Birthing units also continue alongside secondary and tertiary maternity services at Dunedin and Southland hospitals. The feasibility of a primary birthing unit in Dunedin will also be considered.

In all, the Southern district maternity system will have eight birthing units and five primary maternal and child hubs to support women and their babies, working with other complementary community and primary care services.

The development of the plan has been a two-year process that has been necessary to catch up with changes to population and workforce needs.

“The current system had evolved through a range of circumstances and historical situations. Over time, some gaps and inequities had developed, with resources not well distributed across the district,” says Southern DHB Chief Executive Chris Fleming.

“There had long been calls for developing a more strategic and principles-based view of the system of care from women and care providers alike. Addressing this became urgent as the concerns about the sustainability of the LMC midwifery workforce that had been present from the beginning of the process became critical in some parts of the district. While LMC midwives are paid directly by the Ministry of Health, rather than DHBs, there are steps we can take to provide a more supportive environment for them.”

Ensuring the new primary maternity system of care is aligned with the DHB’s wider Primary and Community Care Strategy was also essential, says Executive Director Strategy, Primary and Community, Lisa Gestro.

“We now have a wide-reaching vision for the future of primary and community health care services, including maternity services, across the district.

“Southern DHB covers the largest geographic area of any DHB, and our climate and geography add further challenges. So we have needed to think differently about how to expand the reach of the care we provide. Developing a new layer of support to LMCs and women through the maternal and child hubs, investing in technology and above all taking steps to support our remote rural LMC midwives to have their work better remunerated as they carry out their all-important roles has been fundamental to this.”

Southern DHB would continue to work with the Ministry of Health on addressing LMC payments to reflect the work of those in remote rural areas, Fleming says.

“Importantly, we are creating a system that has built-in flexibility, so we can adapt to ongoing changes in our populations and community and workforce needs.

“We thank everyone who has contributed to this project over the past two years, including the authors of the more than 200 written submissions, and the people who took time to attend community meetings or participate in focus group discussions. This input was listened to and has helped shape the decisions that have been made, and ensure the system of care is robust, sustainable, and addresses the needs of the community.

“We look forward now to moving ahead to implement a system of care that works for women and families across the district.”